Summary

Background and objective: Endogenous catecholamines are released in brain-dead organ donors following painful stimulation during retrieval surgery, and might be harmful to harvested organs. Our hypothesis was that inhibition of pain by fentanyl would inhibit such catecholamine release.

Methods: We tested 17 brain-dead organ donors in a randomized, placebo-controlled, double-blinded study. Blood samples for determination of epinephrine and norepinephrine concentrations were obtained before and 10 min after in take of either fentanyl 7 μg kg−1 or an equivalent volume of placebo. Further points of measurement were taken after skin incision and sternotomy. Mean arterial pressure and heart rate at these points were recorded.

Results: Catecholamine concentrations rose following painful stimuli. No differences in haemodynamics, between the fentanyl and the placebo group were detectable. Epinephrine concentrations, but not those of norepinephrine, were higher in the fentanyl group, reaching significance following sternotomy.

Conclusion: We conclude that the use of fentanyl (7 μg kg−1) was not effective in suppressing the catecholamine release, following painful surgical stimulation in brain-dead organ donors.

Summary

Background and objective: The visual analogue scale (VAS) is considered as the gold standard method for postoperative pain assessment. Nevertheless, in some clinical situations, this method may not be reliable. We performed an observational study to assess the use of the VAS and other pain scales by nurses in the postanaesthesia care unit.

Methods: We studied the reasons for not using the VAS and asked if it may be less appropriate in certain age groups.

Results: Among 600 patients included in the study (16% = 70 yr), nurses used the VAS in 53%, the numerical rating scale in 30%, the verbal rating scale in 12% and the behavioural scale in 5%. In 43% of the assessments, nursed did not use the VAS; the most frequently cited reason was related to their preference for other methods. In 54% of the assessments, the reason for not using the VAS was related to the patients, mainly when they were in too much pain to use it (22%). When the patient was in too much pain, the numerical rating scale was chosen in 54% and the behavioural scale in 27%. There was no difference between young patients and elderly patients.

Conclusions: Although the VAS is the standard method to assess pain, the nurses preferred using the numerical rating scale, both spontaneously or when VAS assessment was not possible.

Summary

Background and objective: Pain is often experienced when propofol is injected, and intravenous lidocaine is often effective in preventing such pain. We decided to determine whether metoprolol, given before the injection of propofol, is as effective as lidocaine in reducing the incidence and severity of the pain.

Methods: Ninety patients scheduled for elective surgery under general anaesthesia were randomly allocated to one of three groups to receive either metoprolol 2 mg, lidocaine 20 mg or saline 2 mL before any propofol was injected. Each patient was given one of these agents intravenously via a 20-G cannula on the dorsum of the hand whilst the venous drainage was occluded manually, at the middle of the forearm, for 45 s. After the occlusion was released, propofol 2.0–2.5 mg kg−1, at room temperature, was injected at 2 mL (20 mg) every 4 s. Pain was assessed verbally and scored as none (0), mild (1) or severe (2).

Results: The incidence of severe pain in the control group (56.7%) was significantly higher than in the metoprolol and lidocaine groups (16.6 and 10%, respectively). The number of patients who were free of pain was significantly higher in those who had been given either metoprolol or lidocaine.

Conclusions: Pretreatment with intravenous metoprolol was equally as effective as lidocaine in reducing the pain associated with propofol injection.